A continuing tragedy of maternal mortality in a rural referral center in Northeast Nigeria: A wake‑up call

Context: While reasonable progress has been made worldwide in reducing maternal mortality at the end of the millennium development goal, the same cannot be said of underserved rural communities where the tragedy continuous unabated.Aim: To determine the maternal mortality ratio, causes, and some socioeconomic determinants of maternal deaths in the last triennium of the Millennium Development Goal (MDG) in a rural tertiary center in Northeast Nigeria.Materials and Methods: Retrospective descriptive study of maternal mortality at the Federal Medical center (FMC) Nguru,Northeast Nigeria from January 1st 2013 to December 31st 2015. The center attends largely to underserved rural populace. Results were presented in simple percentages and means with a P value <0.05 considered as significant.Results: The maternal mortality ratio for the triennium was 7,364/100,000 live births with 2015 having the highest MMR of 8,517/100,000. Majority of the deaths occurred in unbooked (n = 87; 46.5%) women with no formal education (n = 120; 64.2%). A third of the maternal deaths occurred in women at the peak of their reproductive age of 25 to 34 years (n = 69; 36.9%). Grandmultiparity is a major risk factor for maternal deaths (43.9%; P = 0.02) compared to nulliparous women (31.5%; P = 0.08). Eclampsia (n = 64; 34.2%), Obstetrics hemorrhages (n = 22; 11.8%) and sepsis (n = 18; 9.6%) still remain the most common direct causes of maternal deaths while anemia was responsible for nearly 60% of the indirect causes. Significant number (36%) of these women reside in communities with secondary or tertiary health care facilities. Majority (39.5%) presented to a health care facility more than 24 hours from the onset of obstetric incidence with 52% of them dying within 24 hours of presenting to the FMC. Interestingly, 82% of the deaths from Nguru local government area are in those who reside within 5 kilometers of the FMC.Conclusion: This region has consistently maintained high MMR but this ratio of 7,364/100,000 live births is the highest so far. The causes of maternal deaths are still the same as they were 2 decades ago. The question still remains unanswered: why are many women not seeking healthcare services even when it is as close as 5 km from their residence? Why do women present with obstetric emergencies when over 70% of them reside were there are health care facilities? We recommend further research to answer these questions and to guide policies and programs that will lead to the achievement of sustainable development goal 3.1 by the year 2030.Keywords: Last triennium; maternal death; maternal mortality ratio; rural referral cente

Prevalence, risk factors, and outcomes of obstructed labor at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Introduction: Obstructed labor is a common cause of feto-maternal morbidity and mortality in Maiduguri, Nigeria. This study aimed to determine the prevalence, causes, risk factors, and outcome of obstructed labor at the University of Maiduguri Teaching Hospital (UMTH). Materials and Methods: This was a retrospective observational study of all cases of obstructed labor managed from January 2012 to December 2014 at the UMTH, Maiduguri, Nigeria. For each case, the next woman who delivered without obstruction was used as a control. Data were analyzed for sociodemographic variables, labor, delivery and postdelivery events using SPSS version 20.0. The Chi-square test and odds ratio (OR) were used and statistical significance set at P < 0.05. Results: The prevalence of obstructed labor was 2.13%. Cephalopelvic disproportion, persistent occipitoposterior position, and malpresentation were seen in 65.37%, 16.58%, and 11.71%, respectively. The risk factors were teenage pregnancy (χ2: 26.96, P < 0.0001, OR: 4.44, 95% confidence interval [CI]: 2.45–8.05), nulliparity (χ2: 50.70, P < 0.0001, OR: 4.63, 95% CI: 2.99–7.15), illiteracy (χ2:53.91, P < 0.0001, OR: 5.26, 95% CI: 3.31–8.33), and unbooked status (χ2: 113.26, P < 0.0001 OR: 11.9, 95% CI: 7.24–19.61). Complications were observed in 37.56% of the women with obstructed labor. The common morbidities were wound sepsis, ruptured uterus, and puerperal sepsis, seen in 16.59%, 13.17%, and 7.81%, respectively. The case fatality rate was 0.98% and perinatal mortality was 34.15%. Conclusion: Obstructed labor is common in Maiduguri. We recommend amelioration of the risk factors through advocacy, girl child education, and public enlightenment on the need for antenatal care and hospital delivery, identification, and referral of high-risk patients

Social and health reasons for lime juice vaginal douching among female sex workers in Borno State, Nigeria

Background: Vaginal douching with lime juice and other agents has been perceived to enhance sexual excitement through sensations of vaginal dryness, tightness or warmth, as well as prevent sexually transmitted infections and restore and tighten the vagina after delivery. Its effectiveness as a contraceptive has also been reported. However, the social and health reasons/consequences of such a practice have not been adequately documented in the communities of Borno State, Nigeria. Objectives: This study aimed to determine the extent of, reasons for, and the reproductive health effects of, the use of lime juice for vaginal douching among the commercial sex workers (CSWs) in selected areas of the three senatorial regions of Borno State, Nigeria. Method: This was a community-based descriptive study conducted among female CSWs in selected communities of Borno State, Nigeria. A sample of 194 CSWs were randomly selected and interviewed on their sexual history and douching practices. Results: One hundred and twenty (62%) respondents admitted practicing vaginal douching with lime juice, with 85% having been CSWs for a period greater than three years. More than half douched for sexual pleasure, hygiene and contraception. Significantly more lime juice users had increased susceptibility to sexually transmitted infections (STIs) than non-users. Users had a higher prevalence of HIV infection than non-users. The Papanicouleaua (pap) smear test for cervical lesions also showed that moderate to severe dysplastic changes were more prevalent among limejuice users. Conclusion: Many CSWs in this community use lime juice for douching, for various reasons. Indications are that its use is associated with a higher prevalence of sexually transmitted diseases, including HIV infections and dysplastic cervical changes. Owing to confounding issues, such as the number of sexual partners, frequency of sexual exposure per day and the duration of exposure, it cannot, therefore, be deduced that douching with lime juice is the only reason for the higher prevalence of STIs and HIV. Nevertheless, there is an obvious need to mount extensive campaigns to educate the CSW on the possible risks of using such a practice

A continuing tragedy of maternal mortality in a rural referral center in Northeast Nigeria: A wake-up call

Context: While reasonable progress has been made worldwide in reducing maternal mortality at the end of the millennium development goal, the same cannot be said of underserved rural communities where the tragedy continuous unabated. Aim: To determine the maternal mortality ratio, causes, and some socioeconomic determinants of maternal deaths in the last triennium of the Millennium Development Goal (MDG) in a rural tertiary center in Northeast Nigeria. Materials and Methods: Retrospective descriptive study of maternal mortality at the Federal Medical center (FMC) Nguru, Northeast Nigeria from January 1st 2013 to December 31st 2015. The center attends largely to underserved rural populace. Results were presented in simple percentages and means with a P value <0.05 considered as significant. Results: The maternal mortality ratio for the triennium was 7,364/100,000 live births with 2015 having the highest MMR of 8,517/100,000. Majority of the deaths occurred in unbooked (n = 87; 46.5%) women with no formal education (n = 120; 64.2%). A third of the maternal deaths occurred in women at the peak of their reproductive age of 25 to 34 years (n = 69; 36.9%). Grandmultiparity is a major risk factor for maternal deaths (43.9%; P = 0.02) compared to nulliparous women (31.5%; P = 0.08). Eclampsia (n = 64; 34.2%), Obstetrics hemorrhages (n = 22; 11.8%) and sepsis (n = 18; 9.6%) still remain the most common direct causes of maternal deaths while anemia was responsible for nearly 60% of the indirect causes. Significant number (36%) of these women reside in communities with secondary or tertiary health care facilities. Majority (39.5%) presented to a health care facility more than 24 hours from the onset of obstetric incidence with 52% of them dying within 24 hours of presenting to the FMC. Interestingly, 82% of the deaths from Nguru local government area are in those who reside within 5 kilometers of the FMC. Conclusion: This region has consistently maintained high MMR but this ratio of 7,364/100,000 live births is the highest so far. The causes of maternal deaths are still the same as they were 2 decades ago. The question still remains unanswered: why are many women not seeking healthcare services even when it is as close as 5 km from their residence? Why do women present with obstetric emergencies when over 70% of them reside were there are health care facilities? We recommend further research to answer these questions and to guide policies and programs that will lead to the achievement of sustainable development goal 3.1 by the year 2030

The benefit of myomectomy in women aged 40 years and above: Experience in an urban teaching hospital in Nigeria

Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1-6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6΁2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6΁8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered